Healthcare Provider Details

I. General information

NPI: 1033139571
Provider Name (Legal Business Name): OBSTERTIX/PEDIATRIX MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/20/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 E 19TH AVE SUITE 5300
DENVER CO
80218-1216
US

IV. Provider business mailing address

1601 E 19TH AVE SUITE 5300
DENVER CO
80218-1216
US

V. Phone/Fax

Practice location:
  • Phone: 303-839-7440
  • Fax: 303-839-7210
Mailing address:
  • Phone: 303-839-7440
  • Fax: 303-839-7210

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License Number42752
License Number StateCO

VIII. Authorized Official

Name: DR. SHELLEY MELISSA LAWRENCE
Title or Position: ATTENDING NEONATOLOGIST
Credential: MD
Phone: 303-839-7440